The Role of Klebsiella pneumoniae in Lung Abscesses: A Geographic Phenomenon (for Now!)

norandrosta-4, 9-diene-3, and 17-dione). He discontinued use of these compounds in September 2004. The results of his laboratory tests are shown in table 1. He did not abuse alcohol or start taking any other new medications, and his viral hepatitis serologic test results and glucose levels were unremarkable. When he was taking these steroid supplements, his 10-year calculated risk of coronary heart disease rose from 1% to 10% [5]. According to a recent review of the literature about AAS use, the prevalence of steroid use among active individuals ranges between 6.2% and 38.4%, and the prevalence among inactive individuals ranges between 0.4% and 9.6%. The prevalence rates obtained from many of the studies did not distinguish single use from prolonged use [7]. Only 1 study has specifically looked at AAS use by HIV-positive, homosexual men; it was found that the prevalence of AAS use was 31.7% [8]. The study did not differentiate therapeutic from nonprescription use. Lipid and transaminase level elevations have been reported in AAS users [9]. We convinced our patients to discontinue AAS use by explaining the long-term cardiovascular implications of their lipid level abnormalities in particular. The importance of asking patients about steroid use is highlighted by a recent study that shows that only 44% of AAS users had revealed their use to physicians [10]. Patient 1 obtained his steroids illegally from an individual supplier; patient 2 bought his (now banned) steroid precursors over the counter. Internet sources are also readily available. Using the Internet search engine Google, we found that the phrase “buy steroids” resulted in 1,900,000 hits. Many of these Web sites provide AAS dosing instructions and regimens, but downplay the drugs’ potential hazards. In summary, prevalence data on AAS use in HIV-positive, homosexual men is sparse, but limited results show that the prevalence of use may be high. AAS use may confound interpretation of liver and lipid level abnormalities in HIV-infected patients who receive HAART. AASs are readily available, and vendors rarely reveal their dangers. HIV care providers should routinely screen their patients for steroid use and educate them regarding the drugs’ adverse effects.